Shahid Akhter, Editor, ETHealthworld spoke to Dr. Manjiri Bakre, founder and CEO of OncoStem Diagnostics, Bangalore to know how the recurrence of cancer can be predicted.

Breast Cancer diagnosis and treatmentBreast cancer incidence is increasing worldwide, not just in India or Asia. The diagnosis is moving at a really fast rate compared to how it was in the past. The methods of diagnosis have improved and a lot of new methodologies are being implemented. In terms of treatment options, surgeries have improved tremendously, non-invasive or less invasive surgeries are being done. The drugs used for Chemotherapy are less toxic and radiation technologies have improved with minimal radiation being given to the patients. In today’s era, a lot of targeted drugs that have minimal side effects are available to the patient. This is helping in increasing the cure rates of cancer.

Does everyone benefit from Chemotherapy? This is a dilemma that clinicians face all the time before prescribing chemotherapy. It is a well-known fact that not all patients benefit from chemotherapy. It depends on the stage of cancer and how big the cancer is. When the cancers are small, the benefit of chemotherapy is less compared to when the cancer is big. When the cancer is spread throughout the body, only then the chemotherapy benefit is huge.

If the cancer is in early stages and tumours are tiny, clinicians always wonder whether the patient will or will not benefit from chemotherapy. This decision of recommending chemotherapy for a patient depends on the aggressive biology of the disease. Currently, there are not too many tools available to understand the benefit of chemotherapy to all patients. The field of breast cancer is fairly advanced and there are prognostic tests available that can help decide the benefit of chemotherapy to the patient. Tests like this must be made available for other cancers as well.

OncoStem Diagnostics - Startup journey so far OncoStem was started in 2011. The seed was sown when I was pursuing my PhD at Indian Institute of Science. A friend of mine at IISc was diagnosed with breast cancer. She detected it herself and underwent surgery soon after. When she was pursuing her post-doctoral fellowship, her cancer recurred in her body in 2-3 sites. Her cancer was aggressive and despite all treatment options, we lost her within 2 years of diagnosis. This made me think that we need to bring more awareness about the course of cancer. We should know about the aggressiveness of cancer so that the patient can really plan their lives accordingly. I noticed that there are other companies in the west who have developed tests that can predict the recurrence of cancer. However, these tests were out of reach for patients here because of the cost and as well as the biology of the disease. These tests were validated on the biology of the patients in the west is different from that of patients in the east. This is when I decided to develop a new test that will help in beneficial treatment planning for our patients. This was the genesis for OncoStem Diagnostics. Funding from Artiman Ventures and Sequoia Capital and building the team at OncoStem.

OncoStem diagnostics is backed by Artiman Ventures and Sequoia capital. They have been extremely supportive of us. Right from giving funding and providing us the space in their office for the lab and research, they have supported us throughout. In the last 8 years, we have worked with 12 different hospitals in India and about 4 hospitals in Europe and the US. We are planning to come out with a couple of studies for the Europe market. We have an excellent team at OncoStem who take care of the science behind, research, laboratory, sales, finance and marketing. Without the support of the team, my idea would not have become a reality today.

OncoStem diagnostics startup journey so far CanAssist Breast is CE-IVD marked and ISO 13485 certified. It is performed as a service from central, NABL and CAP-accredited laboratory in Bangalore.

CanAssist breast can be covered by all private insurance companies. We have had many patients who have received reimbursements from insurance payers.

CanAssist Breast- Impact and acceptance CanAssist Breast falls under the class of prognostic tests. It is performed only on hormone receptor-positive and HER2 negative breast cancer patients in early stages. The test is performed on the patient’s surgically removed tumour sample which is preserved in the hospital laboratories. When a patient is diagnosed with early-stage breast cancer, there is a dilemma in the doctor’s mind whether the patient will benefit from chemotherapy or not. Through this test, they can overcome this dilemma.

CanAssist Breast essentially looks at the biology of the tumour and how aggressive it is. It has been shown in multiple studies that two patients with the same sized tumours, one patient may not have cancer recurrence whereas the other patient may have a recurrence. The difference in these two patients is not the tumour size but the tumour biology. One patient had an aggressive tumour whereas the other patient did not have.

That’s the assessment CanAssist Breast provides. The test assesses the tumour biology in depth by doing immunohistochemistry for five biomarkers which reflects the aggressiveness of the tumour. Once this is done, qualified onco- pathologists grade the slides and the information is then fed into our machine learning-based statistical algorithm. This gives us a definitive risk score and this is reflective of the patient’s risk of cancer recurrence in the next five years. Based on this score, clinicians plan the optimum treatment for the patients. If the risk of recurrence is high, the clinicians will add chemotherapy to the treatment regimen whereas if the risk score is low, the patient can have surgery, radiation and move on to targeted therapies in breast cancer.

CanAssist Breast has been in the market as a prescribed test in the market for the last 1 year. Today, we have about 200 clinicians who are actively prescribing this test and we are currently talking to more than 1200 clinicians regularly to create awareness about the test. Till date, more than 600 patients have availed the test. Typically, about 70% of the patients have a low risk of recurrence. Therefore, you can imagine the kind of impact the test has had. It has helped at least 70% of 600+patients in avoiding unnecessary chemotherapy and its side effects.

OncoStem Diagnostics Future plans CanAssist Breast is currently available in India and near India markets such as Sri Lanka and Bangladesh. In the next two years, we would like to expand in other Asian markets as well because there are patients in other parts of Asia who do get diagnosed with early stages of breast cancer. CanAssist Breast can help them decide the course of therapy. Post entering into Asian markets, we would like to target the Middle East and European market. We are also working on other additional accreditations on this test. Once we have that, we will enter into Western markets such as the US and Canada.

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